Written by AMBUJE CHE TOM LIKAMBALE
Malawi Government cannot cure every social ill by simply throwing money at it. The drug shortage now devastating patients at Malawi’s government-run hospitals, similarly, will not die simply by shooting a large one-time tranche of subvention at it from Treasury for drug purchase. An X-ray of the administrative structure of the Ministry of Health and a catscan of its administrative operations, as well as an EKG of the pulse of individual hospitals, will more than likely reveal the root causes of the malady. At that point a more intelligent diagnosis, the right prescriptions and the needful treatment will be more appropriately applied.
Still, our hospitals are in the Intensive Care Unit (ICU) themselves and dying. One of the biggest embarrassments of our healthcare system in recent years was the news that when a whole President, dictator Bingu Mutharika, arrived unconscious at the Kamuzu Central Hospital (KCH) last April having suffered a stroke, some basic treatments such as Adrenaline were nowhere in evidence and staff had to try to source them from neighbouring private clinics, losing time in the process and reducing the chances of his survival.
Mutharika’s neglect of the healthcare system literally came back to kill him. The spectre of a President dying at a hospital he chronically underfunded himself is pregnant with symbolism and warning: someday one sleeps, or dies, on the mat one laid. Unfortunately, this is a pearl of wisdom which the tin-pot dictator did not understand when he was President. The larger tragedy, however, would be for future leaders to similarly fail to grasp such a trite lesson. If meaningful changes do not arrive quickly, our hospitals will die and kill us while they are at it.
Late Elizabeth, mother of the current Queen of England, inaugurated the Group Hospital in Blantyre, Nyasaland, on Friday, 12th. July 1957. Today, rechristened the Queen Elizabeth Central (QECH), it remains the largest referral hospital in Malawi with roughly 1,200 beds. What I saw when I went there to see a patient 3 years ago, at the height of the Mutharika dictatorship, left me gasping with incredulity. It was not the same hospital where my eyesight had been saved when I was a pubescent boy in the mid-1970s. In some sections even the physical structure of the hospital appeared to need an MRI screening.
The wards looked unkempt and the patients in them forlorn with foreboding. I had gone with a friend to see her uncle, and tales of death from the previous nights were still being spoken among guardians of patients.
My discomfort was enough to send me to see another friend, a senior member of staff at the hospital, to understand what had gone so wrong since the hospital’s heyday. For fear of the Mutharika dictatorship, my friend admonished me to keep his identity undisclosed if I wanted to write publicly about the situation. I assured him that if I used an identifier for him, I would use his nickname Kutikula Kwandanda (the first born), and Mutharika would be none the wiser.
Erratic Subvention; Poor Equipment
Kwandanda informed me that the hospital got money on a monthly basis from government, but that the amounts varied each month. Sometimes, he said, it got enough for all its needs, but usually it was underfunded. He suggested that big items, those he called ‘capital items’, were procured for the hospital by the Ministry of Health’s headquarters in Lilongwe. He said there had been a recent improvement in the procurement process as the hospital had received permission to buy some items on its own.
Kutikula Kwandanda said Central Medical Stores (CMS), the main supplier of medicines to all government hospitals in Malawi, had not been operating normally for over 6 years due to donor dictation to reform or privatise it. As a result, he reported, hospitals, including the QECH, did not have a steady supply of medicines and what he called ‘other consumables.’ When hospitals had money to buy medicines and ‘other consumables’ from private suppliers, he said, they had to seek permission from CMS first – a process that, he said, was usually slow to the detriment of patient care. Kwandanda said that even as I was talking with him, the hospital lacked gloves, IV fluids and ‘plasma expanders’ (I had no idea what those were, but they sounded like something very important for blood work), and that this had been the case for years.
The QECH, according to Kwandanda, had not improved to the expected level as the biggest referral hospital in the country. He said the QECH did not have a working CT Scanner, an old one having broken down a year earlier and not been repaired nor replaced. Cancer patients, he said, were dying every week due to lack of diagnostic equipment, radiotherapy and chemotherapy medicines. At that point, the hospital had only one 4-bed Intensive Care Unit (ICU) with only one ventilator to help patients that were unable to breathe. In recent days, he reported, major operations requiring ICU admission post-surgery were cancelled indefinitely due to these inadequacies. Some on the waiting list died before treatment despite the situation being brought to the attention of hospital administrators and ministry headquarters in good time. Kwandanda suggested that nobody that mattered and could implement changes, including dictator Bingu Mutharika, seemed to care.
What is a hospital without water, wondered Kwandanda rhetorically? Blantyre Water Board, said he, sometimes failed to supply water to the hospital and this was a long standing problem. However, Kwandanda agreed with me that it was simply mind boggling that, given that situation, the hospital (or ministry headquarters) did not think about having a water reserve tank that could supply emergency water for at least a day. Kutikula Kwandanda said that operations were sometimes cancelled due to the water shortage to avoid infecting patients with dirty equipment and an unsanitory environment. The water shortages also affected other emergency care operations and added significantly to the QECH’s haste to hell in a hand basket.
Shortage of Staff, Poor Administration
Kutikula Kwandanda decried the shortage of nurses and clinicians. He said quite a few of them had been trained recently and posted to QECH, but could not take up their postings because they could not find accommodation in town. Houses might be available, he said, but the new staff could not manage the high rentals. Government paid its staff house rent money, he said, but it was too small to pay minimal rents in town.
The hospital, he reported, required twice the number of nurses available at that point. Just 2 weeks earlier, there had been no nurse to work in the Labour Ward. Pregnant mothers readying for delivery had been turned back. A hospital matron had to be called in at night to help with deliveries of mothers that had already been admitted.
The ICU, too, had often cut the number of admissions due to shortage of nurses. This, lamented Kwandanda, was a problem no one was looking into! It was as if no one cared.
Hospital administrators presented another problem, he said. None of them went around to check how things were going and to identify problems and potential problems. Kwandanda said the administration only woke up when there was an urgent issue to attend to, and at that point, it would usually be too late to save the situation.
(In the next installment, the author will suggest ways to address the dire straights in which the healthcare system in Malawi finds itself).
The Author, Ambuje Che Likambale, is from Balaka Township, Malawi